CONTACT 0860 002 101 | EMERGENCY 0860 255 426
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WHATSAPP: 063 033 1313 | speakout@beheard.co.za

MEMBERSHIP RULES

REGISTERING DEPENDANTS

Register your spouse (legal or custom), life partner, own, step or legally adopted children under the age of 21, and immediate family for whom you are liable. Adult rates apply for dependants over 21 and proof of dependency and relationships are required.

AFTER RETIREMENT

If your employer continues to participate in the Scheme fully and you have been a member of either the Alliance-MidMed Scheme or another Scheme for five consecutive years, you can remain a member after retirement.

TERMINATION

We are a closed Scheme; therefore, membership terminates when you resign from your employer or the Scheme while you work at the same employer. We require one calendar month’s written notice, sent to us via your employer. We will terminate your membership if you do not pay amounts due, or if you or your dependants commit fraud. Your ex-spouse does not qualify for membership and removal of your spouse before divorce finalisation, require completion of an “Instruction to Remove a Dependant” form.

SHOULD THE PRINCIPAL MEMBER PASS AWAY

If the principal member passes away, their dependants may choose to remain members of the Scheme. Surviving spouses may remain, members of the Scheme, if they:

are registered as dependants at the time of the member’s death, can prove that his/ her employer does not provide for medical scheme membership; the deceased principal member had been a member of either Alliance-MidMed or another Scheme for five consecutive years.

Should the surviving spouse remarry, membership of the Scheme will terminate. Pensioners or surviving spouses who wish to terminate their membership must notify the Scheme in writing.

CHANGES ON MEMBERSHIP

Notify us of marital status changes, birth or legal adoption of a child, dependants who no longer qualify for membership, address changes and bank account changes, by using our standard forms.

BANKING DETAILS

Please note the payroll dates when you submit documentation that must be verified by the employer. Bank account changes require verifications like those at your bank.

UPON JOINING THE SCHEME

You must complete a health questionnaire when you apply for membership and when you apply to join dependants. The questionnaire is a legal document and non-disclosure, or incomplete responses can cause termination of membership. (You are responsible to ensure completeness and accuracy of the required information).

LATE JOINERS

We charge late-joiner penalties, and exclusions and waiting periods apply to protect the interests of the Scheme and all members.

Contact us at 0860 00 2101 or for more information, or refer to www.alliancemidmed.co.za.

PROOF OF MEMBERSHIP

When your membership application has been processed, you will be issued with a membership card(s). Your membership card reflects your membership number, yours and your registered dependant's names and dates of birth and the dates from when you are entitled to benefits. Please look after your card and do not lend it to anyone as fraudulent use of cards may lead to the suspension or termination of your membership.

DECLARATIONS, WARRANTIES, UNDERTAKINGS

ALLIANCE MID-MED MEDICAL SCHEME DECLARES THAT

  1. A member’s personal details and medical information (obtained from healthcare providers with the explicit consent of the member) shall be kept confidential.
  2. Member information (personal and health information) will not be used for purposes of related company business nor sold for commercial purposes.
  3. The medical scheme has data security measures in place.
  4. The medical scheme has granted access, to certain persons within the organisation and its contracted third parties, to a beneficiaries’ personal and health information.
  5. All staff within the medical scheme and its contracted third parties are bound by internal confidentiality agreements.
  6. The scheme and its contracted third parties will use the medical/health/diagnosis/procedure information provided for the following purposes: processing the application for membership; reimbursement of claims, determining member entitlement to benefits and risk management practice.
  7. The scheme has ensured that confidentiality agreements have been entered into with all contracted third parties who have access to beneficiary information for the purposes of data transfer and management, scheme administration and managed care arrangements.
  8. In the event of a breach of confidentiality, the medical scheme assumes responsibility and the breach will be managed according to the schemes’ internal protocols.
  9. The terms Scheme and Administrator are used interchangeably.

REQUIRED OF MEMBERS AND DEPENDANTS

  1. Membership is initiated through a duly completed application form and declarations. I hereby apply for my dependants and myself to join Alliance-MidMed Medical Scheme, administered by Alliance-MidMed Medical Scheme (the Administrator).
  2. Members are advised that any breach of any warranty or non-disclosure of any information by the member or dependants that is relevant to the assessment of member applications or medical conditions will nullify contracts / agreements / undertakings and the member will forfeit all contributions that I paid to Alliance MidMed Medical Scheme. In such an event Alliance-MidMed Scheme will have the right to reclaim any amounts that Alliance-MidMed Medical Scheme may have paid to me or any person on the member / dependant’s behalf under such contracts.
  3. The Scheme reserves the right to take legal action where appropriate.
  4. The member will notify Alliance-MidMed Medical Scheme if any alteration takes place in any circumstances on which Alliance-MidMed Medical Scheme based its assessment of its risk upon application and relating to any procedure and before the date of Alliance-MidMed Medical Scheme acceptance of the risk. Failure to do so will make any contracts to which this application relates null and void. In such an event Alliance-MidMed Medical Scheme will have the right to reclaim any amounts that Alliance-MidMed Medical Scheme may have paid to the member or any person on the member or dependant’s behalf under the contract.
  5. Members are made aware of, and accepts the Schemes Rules, as they may be updated form time to time. The Scheme Rules are registered and are decisive in the case of a dispute. Members are provided with an opportunity to read the Alliance-MidMed Medical Scheme rules before signing the membership application form and the Rules are available at the Scheme office.
  6. Members, through their membership and authorising the monthly payment of contributions, authorise access to any medical or other information required by Alliance-MidMed Medical Scheme or the Administrator during the process of assessing their membership and treatment as well as any further claims procedures. Members furthermore authorise service providers to provide ICD10 codes on all my and any dependants’ accounts.
  7. Members undertake to notify Alliance-MidMed Medical Scheme, through obtaining pre-authorisation, should dependants require hospitalisation for a non-emergency event and acknowledge that failure to do so will result in a penalty being applied or a reduction in benefits provided by Alliance-MidMed Medical Scheme for any procedure undertaken.
  8. No benefit will be payable by Alliance-MidMed Medical Scheme unless the Scheme is satisfied as to the validity of any claim and have received all the information which they may require from dependants.
  9. Members consent to Alliance-MidMed Scheme addressing any request for information, tests or examinations directly to any dependant over the age of 21 (twenty one), with the same legal consequences as if the request had been addressed to members in their capacity as a principal member.
  10. On termination of membership with Alliance-MidMed Medical Scheme as per the agreed termination period, members shall repay any amount by which claims paid out of savings exceed contributions paid into such account, on demand. The member further agree/acknowledge that termination of membership does not entitle them to contribution refunds and any indebtedness due to Alliance-MidMed Medical Scheme which have been deducted while membership was active.
  11. Members authorised the deduction of monthly contribution and any other indebtedness due to Alliance-MidMed Medical Scheme as per the deduction amount agreed upon and understand it is their sole responsibility as a member of Alliance-MidMed Medical Scheme, to ensure that the monthly contribution is received by Alliance-MidMed Medical Scheme. Non-receipt of two consecutive month’s contributions will result in the termination of membership. Members further acknowledge/agree that my authorisation to deduct my monthly contributions will be treated as payment instruction issued personally by the member as the account holder. Membership may not be ceded.
  12. In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day. Membership numbers serves as my reference number.
  13. Members undertake to obtain the necessary consents from any dependants to whom these conditions may apply and indemnify Alliance-MidMed Medical Scheme against any claim which may arise as a result of my failure to do so.
  14. Members accept that in the case of new Alliance-MidMed Medical Scheme members, the following may apply:
    1. A three-month general waiting period
    2. A twelve-month exclusion on a pre-existing condition
    3. Late-joiner contribution penalty.
  15. Members acknowledge that should any documents be submitted via the internet or facsimile, it is solely for the purposes of convenience and neither the member nor the Scheme (subject to its sole discretion) will rely on the information herein contained without the Member first providing Alliance-MidMed Medical Scheme with a signed hard copy of this application.
  16. The member agree that their application and the continuation of monthly contributions constitutes an offer on my part for membership with Alliance-MidMed Medical Scheme.
  17. Alliance-MidMed Medical Scheme shall be entitled to obtain credit and related information concerning myself at any time and lodge, exchange and disclose such information with any credit bureau without any further notice to me. Alliance-MidMed Medical Scheme shall be entitled to verify such information and to make any queries it deems necessary. In the event of a negative credit record, Alliance-MidMed Medical Scheme will not advance saving benefits for non-essential healthcare without the member lodging a bank guarantee with Alliance-MidMed Medical Scheme.
  18. Members consent to all conversations between myself and Alliance-MidMed Medical Scheme and the administrator being recorded and regard all information obtained through these conversations as part of Alliance-MidMed Medical Scheme and the administrator being recorded and regard all remaining the sole property of Alliance-MidMed Medical Scheme.
  19. The member warrant that the contents of all communications with the Scheme are true, correct and complete.
  20. Online Access
    • The member accept that Alliance-MidMed Medical Scheme will not in any way be responsible or liable for any claims of any nature whatsoever made by anyone which arise as a result of the member failing to keep passwords and usernames secure and confidential.
    • Online Access – the Member indemnify Alliance-MidMed and hold it harmless against any such claims.
    • Online Access – the Member understand that this service may not be available 24 hours a day.